aDepartment of Epidemiology bDepartment of Global Health cDepartment of Pediatrics, University of Washington, Seattle, Washington USA dDepartment of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya eDepartment of Medicine, University of Washington, Seattle, Washington USA.
AIDS. 2013 Nov 13;27(17):2809-15. doi: 10.1097/01.aids.0000432540.59786.6d.
HIV-exposed uninfected (HEU) infants have higher infectious disease morbidity and mortality than unexposed infants. We determined the incidence and risk factors for pneumonia, a leading cause of infant mortality worldwide, in a cohort of HEU infants. Identifying predictors of pneumonia among HEU infants may enable early identification of those at highest risk.
A retrospective cohort of HEU infants participating in a Kenyan perinatal HIV study, enrolled between 1999 and 2002.
Infants were followed monthly from birth to 12 months. Incidence of pneumonia diagnosed at monthly study visits, sick-child visits or by means of averbal autopsy was estimated with a 14-day window for new episodes. Cox proportional hazards regression was used to identify predictors of first pneumonia occurrence.
Among 388 HEU infants with 328 person-years of follow-up, the incidence of pneumonia was 900/1000 child-years [95% confidence interval (CI) 800-1000]. Maternal HIV viral load at 32 weeks' gestation [hazard ratio 1.2 (1.0-1.5) per log10 difference] and being underweight (weight-for-age Z-score <-2) at the previous visit [hazard ratio 1.8 (1.1-2.8)] were associated with increased risk of pneumonia. Breastfed infants had a 47% lower risk of pneumonia than those never breastfed [hazard ratio 0.53 (0.39-0.73)], independent of infant growth, maternal viral load and maternal CD4%. Breastfeeding was also associated with a 74% lower risk of pneumonia-related hospitalization [hazard ratio 0.26 (0.13-0.53)].
The incidence of pneumonia in this cohort of HEU infants was high. Our observations suggest that maternal viral suppression and breastfeeding may reduce the burden of pneumonia among HEU infants.
艾滋病毒暴露未感染（HEU）婴儿的传染病发病率和死亡率高于未暴露婴儿。我们在肯尼亚围产期 HIV 研究中确定了一组 HEU 婴儿中肺炎的发病率和危险因素，肺炎是全球婴儿死亡的主要原因。确定 HEU 婴儿肺炎的预测因素可能使那些风险最高的婴儿能够得到早期识别。
这是一项回顾性队列研究，纳入了 1999 年至 2002 年间参与肯尼亚围产期 HIV 研究的 HEU 婴儿。
婴儿从出生到 12 个月每月进行随访。在每月的研究访问、生病儿童访问或通过口头尸检诊断出肺炎的新发病例的发病率，采用 14 天的新发病例窗口进行估计。使用 Cox 比例风险回归分析确定首次肺炎发生的预测因素。
在 388 名 HEU 婴儿中，有 328 人年的随访，肺炎发病率为 900/1000 人年[95%置信区间（CI）800-1000]。妊娠 32 周时的母亲 HIV 病毒载量[风险比 1.2（1.0-1.5）每对数差]和上一次就诊时体重不足（体重-年龄 Z 评分<-2）[风险比 1.8（1.1-2.8）]与肺炎风险增加相关。与从未母乳喂养的婴儿相比，母乳喂养的婴儿肺炎风险降低 47%[风险比 0.53（0.39-0.73）]，这与婴儿生长、母亲病毒载量和母亲 CD4%无关。母乳喂养还与肺炎相关住院的风险降低 74%相关[风险比 0.26（0.13-0.53）]。
在本 HEU 婴儿队列中，肺炎发病率较高。我们的观察结果表明，母亲病毒抑制和母乳喂养可能会降低 HEU 婴儿肺炎的负担。
